What is Plantar Fasciitis?

The Plantar Fascia is a thick band of connective tissue that supports the arch of the foot.  This band of connective tissue runs along the bottom of the foot from the heel to the toes.  The plantar fascia is an important energy storing structure acting like a spring to assist pushing off of the foot during walking and running.  Plantar fasciitis occurs when this band of tissue is overloaded and becomes inflamed or irritated.

What Are The Symptoms of Plantar Fasciitis?

1. Pain on the bottom of the foot towards the heal.
2. The pain is usually worse with the first few steps in the morning or after sitting for a long time.
3. Increased pain after weight bearing exercise.

What Are The Possible Causes Plantar Fasciitis?

The possible causes are:

1. Abnormal foot mechanics such as excessive pronation (flattening)
2. Abnormal hip and knee mechanics placing increased stress on the foot.
3. Tight calf muscles placing increased stress on the foot.
4. Wearing shoes that lack arch support.
5. A sudden increase in weight bearing activities such as running.
6. Weight gain placing more pressure on the feet.
7. Pregnancy due to added weight and softening of the plantar fascia due to hormonal changes.

How is Plantar Fasciitis Treated?

We have found the EdUReP (Education, Unload, Reload, Prevention) model to be very effective for treating Plantar Fasciitis.

1. Education: The patient is educated regarding predisposing factors and mechanical faults that may be contributing to overload of the plantar fascia.
2. Unload: A period of rest is recommended and the plantar fascia is unloaded by improving hip and knee mechanics as well as stretching the calf muscles.  Calf stretches must be altered to isolate the stretch to the calf without stretching the plantar fascia (see our self management hand out).  We do not recommend stretching the plantar fascia because we feel that excessive elongation of this tissue is the cause of the pain in the first place.  Orthotics may also be necessary to help unload the plantar fascia.  The pain can often be managed with ice and self massage.
3. Reload: Once the pain is diminished wight bearing exercise is slowly reinstituted into the patients program.
4. Prevention: The patient is further educated regarding ways to prevent recurrence.  This includes instituting recovery weeks into their training program and exercises to maintain proper mechanics of the lower extremity.

We’ve made a self-management handout for treating plantar fasciitis. Click on the link to download.

If Pain Persists and You’re In the Denver Metro Area

Schedule an appointment with our staff of licensed Physical Therapists. We’ll do a thorough exam and evaluation and suggest a course of treatment. If you’re not local to Belmar Physical Therapy then please contact a local, licensed therapist in your area.

What Are Shin Splints?

Shin splints, or medial tibial stress syndrome, is an overuse injury that causes lower leg pain. This problem is the cause in 18% of running injuries and is 2-3 more prevalent in women than men. Shin splints are primarily caused by a mismatch between overload and recovery during weight bearing exercise. High-stress impact loading during running or walking places an increased stress on the lower leg bone (tibia). When this stress increases gradually the bone strengthens in order to handle the load. Shin splints occur when the body’s ability to strengthen the bone is not able to keep up with the stress being placed on the bone. This imbalance of bone strengthening and stress causes small cracks in the bone and inflammation of the surrounding tissue.  The pain from shin splints can be classified into 4 stages in order of severity:

1. Light pain or stiffness after working out.
2. Pain at the beginning of a work-out which dissapears during the warm-up.
3. Pain during the work-out, but also after the workout and during the night. The pain subsides after long rest and inactivity.
4. Constant pain. The pain does not dissapear after rest.

What Mechanical Factors Contribute to Shin Splints?

1. Excessive flattening (pronation) of the feet when walking or running.
2. Tight calf muscles.
3. Weak ankle stabilizer muscles (soleus, flexor digitorum longus, posterior tibialis).
4. Walking or running on hard surfaces.
5. Walking or running in old shoes.

What is the Preferred Treatment for Shin Splints?

1. Ice


Superfeet are an inexpensive orthotics option.

2. Rest (The amount of rest depends on the stage above).
3. Anti-inflamatory medication (prescribed by a medical doctor).
4. Orthotics to support the arch of your foot and decrease the flattening of your feet.
5. Make sure you shoes are not too old (running shoes should be replaced every 300-600 miles).
6. Run or walk on softer surfaces such as dirt.
7. Increase the endurance of your ankle muscles with these exercises.
8. Stretch your calf muscles.
9. Cross-train to give your body a break from high-stress impact loading (cycling and swimming are great choices for maintaining aerobic fitness while resting the injury).
10. When you are ready to resume training, gradually increase your duration and intensity so that the bones can keep up.
11. Prevent recurrence by instituting rest weeks into your training (We recommend an active rest week of 1/2 your usual training duration and intensity every 4th week).

If you live in the Denver or Lakewood, CO area and would like help treating or preventing shin splints give us a call at (303) 274-2404.  If you do not live in our area and have more questions about this or any other orthopedic problem please contact us and we would be glad to help.

For years, the first line of treatment for painful tendons has been anti-inflamatory treatments such as medication and ice.  However, recent studies have concluded that inflamation is not a factor in persistent tendon pain explaining the lack of results with this treatment approach.  These studies have concluded that excessive loading causes weakening of the tendons structure leading to pain. These recent advances in the understanding of tendon problems have lead to the development of the EdUReP (Education, Unloading, Reloading, Prevention) model for treatment.

Treating Tendonitis with EdUReP

Following is a summary of the EdUReP approach.

• Education: The patient is educated in the basic physiology of tendinopathy as well as how their posture and activities may be contributing to overuse of the tendon. The patient and the physical therapist work together to find ways for the patient to perform activities while minimizing stress to the tendon.
• 

  Kinesio tape can help "unload" the painful tendon.

  Unloading: During this phase of treatment the therapist uses patient specific strategies to minimize load to the tendon.  These strategies may include external supports (braces, orthotics or taping), strengthening of other structures that may be underused or stretching of tight structures that are placing more strain on the tendon.

• Reloading:  Once adequate pain control has been achieved through unloading the tendon needs to be strengthened in order for the patient to return to regular activity.  One such strategy is the use of eccentric strengthening exercises discussed in our Get Eccentric” post.  During this stage exercises of progressive difficulty are administered until the patient is able to tolerate the loads required for their particular activity.

• Prevention:  This phase occurs once the patient is able to return to their activities pain free.  Prevention may include re-emphasis of prior education as well as adaptation to technique and form.  The ultimate goal is the patients independence in self-management.
  

  Once adequate pain control has been achieved the patient is given progressive exercises to "reload" and strengthen the tendon.

I was recently reminded of what I do as a physical therapist during an encounter with a friend last week.  My friend is an avid runner and as he has gotten older he has found that he has various aches and pains when running.  Last week he came to me complaining of calf pain and asking if I had any stretches for him.  Luckily I had a little time and I  performed an evaluation.

A rear view of the Tibialis Posterior muscle.

I asked Tom several questions about his pain, analyzed his gait, looked at his feet while standing, performed range of motion tests of his ankle and knee, performed strength tests of his lower leg muscles.  After this evaluation I found that Tom actually had a strain of his Tibialis Posterior muscle.  I explained to Tom that this muscle is underneath the calf muscle and runs to the bottom of the foot to support the arch.  Tom’s arch was collapsing when he put weight on his foot and the Tibialis Posterior muscle was having a hard time controlling this resulting of a strain of the muscle.

I recommended that Tom start using an over the counter orthotic with a firm arch support as well as icing the affected muscle.  Tom called me this morning to tell me that he was no longer having the pain.  Tom then asked me how I knew what the problem was.  

I said to Tom:

“That’s what I do.  I am a Physical therapist.”